Pain Medical Musing

There can be a significant depression issue in chronic pain in which, if you scratch the surface, you find significant underlying anger is actually the issue. Inability to deal with the anger leads to significant depression and self-flagellation and increase suffering. I attempt to suggest to patient to say out loud “I forgive you” in regards to others but finds subjects choke up on that. Now it look like a way in, is to do loving kindness meditation (Tong Len taking and giving). This involves meditation plus imagining breathing in the black “pain” of others while breathing out an aura of happiness to others. My feeling is that doing that to ones you hate could help the issue and give you a sense of relief.

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Spinal cord stimulation is often used as a last resort. To start with, that is a mistake.

Dr. K Kumar pioneered efforts to use spinal stimulation:

Here is a list of some of his articles:
https://scholar.google.ca/scholar?q=Kris+Kumar+spinal+cord+stimulation&hl=en&as_sdt=0&as_vis=1&oi=scholart

I have been practicing long enough in his town to hear him speak and one thing always stuck with me. He bemoaned how long it took for subjects to get to him for treatment as he felt early intervention improved results. Some years ago at a conference, spinal stimulation was discussed but the neurosurgeon was unaware of Dr. Kumar’s 22+ years of experience culminating in that revelation. I was shocked.

So, subjects are seen late, and fail to achieve adequate relief with spinal stimulation even with new modes being used- then what do you do? I try IV pamidronate, ketamine and even methadone might have a place. Now, it looks like adding a stimulator more externally to the outlet of the spinal cord where the dorsal root ganglion is, could make the difference.

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Chronic diseases with negative “blood work” might in fact be  a cytokine inflammation disease. Moderate fibromyalgia has now be found to be a cytokine inspired disease.

I wrote about importance of cytokines 12 years ago:
Cytokine Inflammation Diseases Will Be the Diseases of the 21st Century
http://painmuse.org/?p=361

Then connection to multiple diseases were seen (headaches, irritable bowel, diabetes, alzheimer’s, chronic pancreatitis, chronic fatigue, depression and now depression.

Back in 2013 I wrote a draft that was never published:
“Could Elevated Cytokines Become a Test For Fibromyalgia (FM)?” Now it has.

Below is an update on tests in Fibromyalgia and cytokine relation

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I have found for years that pure cannabinoid (CBD) seemed to have little impact in significant = more likely neuropathic pain.  I tired to get subjects to at least have 1/4 portion of THC but elderly subjects would have nothing to do with spacing out meds. Now the animal model has shown that pure CBD has little impact on neuropathic pain. Marijuana sites pride themselves in regulating cannabis doses as they consider doctors  idiots when it comes to that. However, when you look at their titrations, it is very down-scaled and not likely to have impact for 3-6 weeks. Due to expense, many of my trial users give up on the med.

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Now that it looks like Rheumatoid Arthritis could be infection driven, the benefits in a study of Clavulin (amoxicilin + clavulanic acid) needs revisiting. It has been know for a long time that certain antibiotics have “anti-inflammatory properties”. Now it might be interpreted that they control bacteria that could augment inflammation. A study of plain amoxicillin did not work.

Does that mean that Clavulin controls this inflammation by having wider antibiotic spectrum and should it engender new respect? Could certain antibiotics work like they do in rheumatoid arthritis and reduce inflammation?

Anti-inflammatories “NSAID’s” work poorly in ankylosing spondylitis. Methotrexate does not seem to help.

Prednisone helps but high dose is needed to get any initial response and cannot be used long-term by self especially related to osteoporosis.

Pamidronate is a game changer in chronic back pains particularly where inflammation is missed.  Mixing with prednisone/steroid is possible.

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Recent Study found a strain of previously unrecognized strain of Subdoligranulum in gut was associated with Rheumatoid arthritis (RA) autoantibodies. This bacterium, if introduced into guts of mice, replicated the arthritis seen in humans. This strain is only seen in RA victims.

So, both gut bacterial and periodontal disease can potentially trigger antimmune responses. This leads to new implications on prevention and treatment of Rheumatoid arthritis.

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Our medical college has taken upon themselves the task of antagonizing doctors to point many clinic will no longer even prescribe opioids. They called their program “educational” but demanded doctors respond to them is 2 weeks or else face discipline. No where else in Canada is it that short – BC has 2 “working” weeks which ends up 3 weeks. Some 20 years ago I went to see The then Registrar, Dr. Kendel, and told him 2 weeks was too short but he seemed more concerned that doctors did not take the letter seriously. I got in trouble over that and retired over it.

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Most drugs have little effect on back pain or back pain with sciatica. Surprisingly, a combination of Buprenophine and Pregabalin did seem to make a difference in milder back pain cases.

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I have tested testosterone levels in my chronic pain female patients and found none of them had any detectable levels; they should have some. Supplementation helps.

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Spinal stensois is a horrible disease often thought that surgery is the only outlet (though steroid blocks might have some “limited” effect).  Now again pamidronate has been shown to stem tide of pain with a mean improvement of 40%. Not a controlled trial; but still encouraging. Old study but new to me…

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Studies of too little, too short or too narrow a scope are associated with poor outcome and I am accumulating a list of poorly done studies as I am just fed up. I hope authors take note. I will take me awhile to go thru a compilation of studies I have.

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Selecting people with mildly abnormal hemoglobin A1C (prediabetic), authors found the introduction of Metformin 500 mg twice daily could dramatically relieve widespread pains. Article had to be pulled because consents were iffy and they didn’t have enough in “control group” to prove it didn’t work in non-diabetics. This was May 2019; I have been waiting for them to get consents and a big enough control group but treatment study was never republished. This has remained a secret.

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Raloxifen is a estrogen look alike used for osteoporosis. Is is similar to tamoxifen so helps to prevent breast cancer. Like birth control pills, has a slight stroke risk.

I have a relative who had been on raloxifen for Osteoporosis. It, in combination with other meds has been relatively effective. Her sister has had a fracture, worse hearing loss, and was at one point diagnosed with Fibromyalgia.

It turns out, and article with no referencing to, described raloxifen as a treatment for fibromylagia pain and fatigue in a double blind trial. The study was never repeated and came on it by accident. Pain was cut to more than half in 4 months and fatigue helped as well.

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Techniques involving post isometric relation stretching of Quadratus Lumborum clinic use.

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While gabapentin might work in post herpetic neuralgia and diabetic neuropathy, it does not work well in spinal pains/sciaticas and so forth. Now it has been shown not to work in chronic pelvic pains as well.

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